Effectiveness of a clinical decision-support tool on adherence to prescribing and practice guidelines of high-risk antidepressant medications in geriatric patients

Abstract

Introduction: TCAs and paroxetine, a SSRI, are associated with safety risks in geriatric patients because of anticholinergic properties. The purpose of this project was to evaluate the impact of a clinical decision-support tool (CDST) on adherence with medication prescribing and practice guidance to enhance patient safety. Methods: Mental health clinical pharmacy specialists and clinical pharmacy leadership led a multidisciplinary creation and integration of a CDST within a Veterans Health Administration EHR. The CDST focused on the following elements when prescribing TCAs and paroxetine in geriatric patients: clinical justification for initiation of the medication, provision of patient/caregiver education specific to the medication prescribed, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation. Following activation of the CDST in the EHR, measures were evaluated before intervention and after intervention. Results: After intervention, an increase was observed in the primary outcome of the proportion of patients having documentation of all of the following: clinical justification for medication initiation, provision of patient/caregiver education, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation (P=.01). Individual proportions of patients with documented medication reconciliation and follow-up completed within 30 days significantly increased. All other secondary outcomes numerically increased but did not reach statistical significance. Discussion: Improvement was seen in adherence with prescribing and practice guidance following the implementation of the CDST. This suggests the beneficial role of CDSTs within the EHR to optimize patient safety.

Keywords

• tricyclic antidepressant
• paroxetine
• antidepressant
• clinical decision-support tool
• patient safety
• clinical pharmacy